Editor. David F. Chang, MD Clinical Professor University of California San Francisco, California Altos Eye Physicians Los Altos, California

Transcription

1 Editor David F. Chang, MD Clinical Professor University of California San Francisco, California Altos Eye Physicians Los Altos, California Associate Editors Terry Kim, MD Associate Professor of Ophthalmology Duke University School of Medicine Director of Fellowship Programs Associate Director, Cornea and Refractive Surgery Duke University Eye Center Durham, North Carolina Thomas A. Oetting, MS, MD Clinical Associate Professor of Ophthalmology University of Iowa Department of Ophthalmology and Visual Sciences Iowa City, Iowa Delivering the best in health care information and education worldwide

2 Dedication... x Acknowledgments...xiii About the Editor... xv About the Associate Editors...xvii Contributing Authors...xix Preface...xxiii Foreword by I. Howard Fine, MD... xxv Section I Preoperative Questions... 1 Question 1 With Coexisting Macular Disease, How Can I Tell Whether It Is Worth Doing Cataract Surgery?... 3 Douglas D. Koch, MD Question 2 When Can Cataract Surgery Alone Be Performed in Patients With Fuchs Dystrophy?... 7 Walter J. Stark, MD Question 3 What Should I Do Differently for Glaucoma Patients? Bradford J. Shingleton, MD Question 4 Which Patients Need a Combined Glaucoma Procedure? Thomas Samuelson, MD Question 5 What Should I Do Differently in Patients at Higher Risk for Retinal Detachment? Richard J. Mackool, MD Question 6 With How Large a Zonular Dialysis Can Phaco Be Performed? Bonnie An Henderson, MD Question 7 Question 8 Question 9 I Have a Cataract Patient With a Traumatic Iris Defect and Glare Symptoms. What Should I Do? Francis W. Price, Jr, MD How Important Is It to Reduce or Eliminate Spherical Aberration and Is There an Advantage to Having Some Present? Jack T. Holladay, MD, MSEE, FACS What Intraocular Lens Should I Use in the Postkeratorefractive Patient? Warren E. Hill, MD, FACS

3 vi Question 10 Question 11 Question 12 Question 13 How Do I Perform Cataract Surgery in Eyes With a Phakic Intraocular Lens? Paul Koch, MD When Should I Use a Toric Intraocular Lens Versus Astigmatic Keratotomy Versus Laser Bioptics? Kerry D. Solomon, MD My Astigmatic Keratotomy Results Are Unpredictable. How Can I Improve Them? R. Bruce Wallace III, MD, FACS For How Long Should Topical Antibiotics and Nonsteroidal Anti-Inflammatory Drugs Be Used Before and After Cataract Surgery? Francis S. Mah, MD Section II Intraoperative Questions Question 14 Under Topical Anesthesia, the Patient Is Uncooperative and Complaining of Pain. What Should I Do? Kenneth J. Rosenthal, MD, FACS Question 15 How Should I Proceed if I Made a Poor Clear Corneal Incision? Randall J. Olson, MD Question 16 What Should I Do if the Chamber Is So Shallow That It Does Not Deepen Much With Viscoelastic? Johnny Gayton, MD Question 17 My Capsulorrhexis Flap Tore Radially. How Should I Proceed? Rosa Braga-Mele, MEd, MD, FRCSC Question 18 Question 19 Question 20 Despite Attempting Hydrodissection, I Cannot Rotate the Nucleus. How Should I Proceed? William J. Fishkind, MD, FACS Following Hydrodissection, the Iris Is Prolapsing and the Globe Is Very Firm. How Should I Proceed? I. Howard Fine, MD How Do I Proceed if I See a Small Wound Burn With Whitening of Corneal Stroma? How Would I Close a Severe Corneal Burn? Robert H. Osher, MD

4 vii Question 21 Question 22 Question 23 Question 24 Question 25 Question 26 Question 27 Question 28 Question 29 Question 30 Question 31 Question 32 How Should I Manage a Small or Large Descemet's Membrane Detachment? Terry Kim, MD After Inserting the Phaco Tip, the Chamber Dramatically Deepens and the Patient Complains of Pain. How Should I Proceed? Robert J. Cionni, MD What Should I Do Differently With a Posterior Polar Cataract? Samuel F. Masket, MD What Should I Do Differently With a Hypermature White Cataract? Steve A. Arshinoff, MD, FRCSC What Is the Best Way to Manage Intraoperative Floppy Iris Syndrome? David F. Chang, MD After Chopping or Cracking a 4+ Nucleus, a Leathery Posterior Plate Still Connects the Fragments Centrally. How Should I Proceed? Roger F. Steinert, MD During Phaco, the Posterior Capsule Is Trampolining More Than Usual. How Should I Proceed? Barry S. Seibel, MD What Are the Earliest Intraoperative Clues of Posterior Capsular Rupture? Lisa B. Arbisser, MD The Capsular Bag Is Unexpectedly Mobile During Phaco. When Should I Implant a Capsular Tension Ring and Which Size Should I Use? Iqbal Ike K. Ahmed, MD, FRCSC What Should I Do When the Diameter of My Completed Capsulorrhexis Is Very Small? Howard V. Gimbel, MD, MPH, FRCSC, FACS When Should an Anterior Vitrectomy Be Performed Via the Pars Plana Versus the Limbus? Louis D. Skip Nichamin, MD When and How Do I Stain the Vitreous With Intracameral Kenalog? Scott E. Burk, MD, PhD

5 viii Question 33 Question 34 Question 35 Question 36 Question 37 When and How Should I Implant an Intraocular Lens in the Ciliary Sulcus? Thomas A. Oetting, MS, MD When and How Should I Suture Fixate a Posterior Chamber Intraocular Lens? Elizabeth A. Davis, MD, FACS When and How Should I Implant an Anterior Chamber (Angle-Supported) Intraocular Lens? Manus C. Kraff, MD Based Upon the ESCRS Randomized Study, Should I Use Intracameral Antibiotics? Which Agent? Eric D. Donnenfeld, MD When Do You Use Intracameral Drugs (and at What Dosages) for Cataract Surgery? James P. Gills, MD Section III Postoperative Questions Question 38 What Is the Best Way to Prevent and Manage Postoperative Intraocular Pressure Spikes? Richard A. Lewis, MD Question 39 Question 40 Question 41 Question 42 On Postoperative Day 1, the Anterior Chamber Is Shallow and the Patient Is Unexpectedly Very Myopic. What Should I Do? Luther L. Fry, MD Following Uneventful Surgery, Three of My Eight Patients Have 4+ Cell and Fibrin on Postoperative Day 1. What Should I Do? Nick Mamalis, MD How Should I Manage Prolonged or Recurrent Iritis Following Uncomplicated Surgery? Michael B. Raizman, MD For How Long Can I Safely Observe a Piece of Descended Lens Material? Stanley Chang, MD Question 43 How Should I Manage a Postoperative Refractive Surprise? Mark Packer, MD

6 ix Question 44 Question 45 Question 46 Question 47 Question 48 Question 49 What Causes My Patients to Complain About Temporal Shadows or Reflections, and How Should I Manage Persistent Symptoms? Kevin M. Miller, MD What Should I Do About the Second Eye in a Patient Complaining About Severe Halos After the First Multifocal? Kevin L. Waltz, OD, MD Can I Mix Different Multifocal Intraocular Lenses or Multifocal With Monofocal Intraocular Lenses? Richard L. Lindstrom, MD Following a Posterior Capsular Rent, the Sulcus-Fixated Intraocular Lens Has Become Decentered. How Should I Proceed? Garry P. Condon, MD How Do I Explant an Intraocular Lens 6 Months Following Surgery? Stephen Lane, MD My Pseudoexfoliation Patient Has Newly Discovered Pseudophacodonesis 5 Years Following Surgery. How Should I Proceed? Alan S. Crandall, MD Financial Disclosures Index

7 Preface The informal curbside consult is a commonplace occurrence in every field of medicine. This is where a busy clinician, when faced with a diagnostic or treatment dilemma, solicits practical advice from a knowledgeable expert. Every day, these brief consultations take place in clinic hallways, over the telephone, and by . The question is brief and concise. The advice is practical, to the point, and based upon that expert s knowledge, judgment, and experience. This textbook on cataract techniques seeks to provide a compendium of this information answers to the thorny questions most commonly posed to specialists by practicing colleagues. This educational question-and-answer format is unique among other publications. Just as a curbside consult is distinguished from a lecture or an instruction course, so is this compilation different from a scientific journal or standard textbook. Most of these clinical questions do not individually merit a lecture, review article, or book chapter. In most cases, these questions are not answered definitively by the scientific literature. The questions were compiled by my associate editors and myself and then posed to 49 of the top cataract consultants in North America. We have divided the book into 3 sections: preoperative, intraoperative, and postoperative questions. The advice from our surgical consultants is based upon personal experience, their review of the evidence-based literature, and in some cases, their own clinical studies. I asked that our consultants answers meet my 4 criteria of content the 4 Cs. The advice must be current (timely), concise (summarizing), credible (evidence based), and clinically relevant (practical). As you read, imagine that you have tracked down and then posed your question to a leading authority by , telephone, or in person. Whether you read the book from cover to cover, read 1 question at a time (whenever your schedule allows), or simply employ this as a handy reference for when difficult problems arise, I hope that you will find this novel educational format to be both stimulating and useful. David F. Chang, MD

8 Foreword We ophthalmologists are frequently confronted with patients who represent unusual challenges, and in preparation for those cases, we may consult the literature, surgical atlases, and textbooks. However, most commonly, we call friends, colleagues, associates, or recognized experts in the particular area of challenge. Certainly, the faculty at major meetings are always confronted following their session with ophthalmologists who come to ask questions about one of their patients who present a unique challenge. In this book, David F. Chang, MD has brought together recognized experts in cataract surgery and has given each of them a specific problem to address. The book is appropriately organized into 3 sections: preoperative, intraoperative, and postoperative questions. Each of the questions focuses on a highly specific problem. The authors are all well known and highly recognized for their ability to manage that particular problem and each author describes exactly how he or she handles that situation. The questions are precisely focused and appropriate without being exhaustive or overburdened with caveats. This is a very easily readable and interesting book. The concise nature of each of the questions allows for continuous reading; however, it will probably find its greater utilization as a reference source as surgeons return to the book to deal with a specific problem when it arises. Dr. Chang is an internationally recognized surgeon, teacher, researcher, author, and clinician. It was a brilliant insight to recognize that there is a need for the book, and we are fortunate that he has organized the topics and brought together the faculty to address that need within our resource material. This is a book that will be helpful to every surgeon, from the novice to the expert, and will find its place among the most commonly referred-to sources by anterior segment surgeons. I. Howard Fine, MD Drs. Fine, Hoffman & Packer, LLC Oregon Eye Institute Eugene, Ore